Thursday, January 05, 2006

Nothing better for your mental health than a forced pregnancy

The findings of the The Canterbury Health and Development Study, that there may be a correlation between abortion and mental health problems, aren't as momentous as the Dominion Post wants you to think. The abstract of the article is here. There have been a number of studies, including ones that used this sort of methodology, that looked at the connections. This one had a relatively small sample size, comparing 90 women who had had abortions with 410 who had not. Last year the Royal Australian and New Zealand College of Obstetricians and Gynaecologists did a literature review that examined the link between abortion and mental health problems and came to the following conclusions:

• The overwhelming indication is that legal and voluntary termination of pregnancy rarely causes immediate or lasting negative psychological consequences in healthy women.
• The following factors seem to predict negative psychological outcomes: certain personality traits including impulsivity, attachment, low self esteem and dependency, late gestation abortion, prior psychiatric illness, and conflict with religious or cultural beliefs.
• Overall, the research seems to suggest that greater partner or parental support improves the psychological outcomes for the woman and that having an abortion results in few negative outcomes to the relationship.
• Comprehensive reviews of the adolescent-specific literature have concluded that the effects on younger women are mild and transitory and that other confounding factors may influence negative outcome.
The decision to terminate a pregnancy due to medical or genetic reasons seems to have more of a negative impact often eliciting grief and depression amongst women.
• Some studies have reported positive outcomes such as relief.


This study is entirely consistent with those findings. Why? Because correlation (if correlation exists) does not equal causation. Just because abortion may be linked with mental health problems doesn't mean that it caused those mental health problems. The mental health problems described could make someone more likely to have an unplanned pregnancy, or make it more likely that they'd choose to terminate the pregnancy, or the mental health problems and the abortion (or unplanned pregnancy) could both be caused by something else, like an abusive relationship, or the abortion could cause something (like rejection by anti-abortion nutbars) which cause depression. A simple correlation (particularly in a study this small) doesn't tell us anything about what the relationship between abortion and mental health problems actually is.

I'm arguing the case based on facts but I want to be really clear that even if it was conclusively proved that abortion can cause depression I still absolutely believed abortion should be legal. The only person who can weigh up the risks of giving birth versus the risks of pregnancy is the woman who is pregnant.

There are probably cases where abortion does cause depression, if women are ambiguous about the decision, if they're pressured into it, if they're judged for the decision they make. People can make decisions they regret about abortions, just like they can about everything else, and I really admire Annika Moa for speaking out about her experience. Ken Orr, who is an anti abortionist, apparently believed talking about a woman he knew helped his cause: "I have a friend who cries herself to sleep every night because she can't forgive herself for – as she puts it – killing her baby." That's a really awful situation, I don't know under what circumstances she had an abortion, but I wish that society had provided her with what she needed to continue the pregnancy, if that's the way she felt. But the fact that people regret choices, and feel they made the wrong ones, doesn't mean we should take them away.

Meanwhile SPUC (or whatever they're calling themselves now) are arguing that this shows that 98% of abortions are illegal. As I've written about before New Zealand abortion law is pretty appalling. The law was written by pro-lifers (including David Lange) to try and restrict access to abortion. In order to have an abortion you must have to Certifying Consultants (doctors who have been approved by the Abortion Supervisory Committee not to have views that are contradictory to New Zealand abortion law) say that the abortion will damange your physical or mental health and that this is not just the normal risk of pregnancy (because women should just suck that up). There's one other condition - I think it's that the pregnancy was a result of incest (I know it's not rape because the fuckers voted down an mendment to make rape an automatic ground for abortion, because then women would claim they had been raped to get an abortion, and I will not be happy until I've danced on every single one of those men's grave). Despite this most women who want an abortion can get one, as 98% of abortions are given for the reason that pregnancy would damage the woman's mental health.

Of course SPUC miss most medical points, as well as the ones I've already made, even if abortion does directly cause mental health problems in a significant number of women, forcing women to continue pregnancies they don't want could very easily cause more mental health problems. The only way to find out would be to turn down half the women who wanted abortions and compare the mental health of the two groups, which is obviously not going to happen. I wonder if SPUC would jump aboard that study on the grounds that it would safe half the 'babies'.

But if 98% of abortions are illegal that's an enditement on the law, not on practice. Women shouldn't need to claim that a pregnancy will damage their mental health to get an abortion (although a forced pregnancy would damage my mental health). I have no hope that New Zealand abortion laws will be changed while Labour is relying on the support of Peter Dunne to prop up their government.

NOTE: I've already got a thread where you can discuss the morality of abortion. If you want to discuss the morality of abortion go discuss it in this thread. This thread is to discuss the study. If someone tries to discuss the morality of abortion those posts will be deleted, please do not engage with that argument.

UPDATE: Go and check out Tigtogblog who makes this important point (among others):
The trends do appear to hold, although I see no indication that there was any comparison with women who had continued with unplanned pregnancies, a distinction I would think crucial.
Amanda at Pandagon also has a good discussion.

11 comments:

  1. Anonymous10:38 am

    You can guarantee that the anti-abortionists will focus on this one small study, rather than the collected findings of many studies that you have pointed to. Fergusson’s studies often emphasise the relative risk as opposed to the actual risk, which the literature suggests is small. Perhaps it is in the full research report. The news report only gives the total risk over the previous four years, not the risk following an abortion.

    “Of those who had an abortion, 42 per cent had experienced depression at some stage in the previous four years, almost double the rate of those who had not been pregnant and a third higher than those who continued with their pregnancies.”

    It’s clear from these results that pregnancy is associated with higher levels of depression (those who had not been pregnant having the lowest rate of depression). About 80 percent of new mothers experience the postpartum “baby blues” soon after birth; postpartum depression occurs in approximately 10-20 of mothers; and postpartum psychosis affects about one tenth of 1 percent. Another condition is birth-related post-traumatic stress disorder, which I hadn’t heard of before. The anti-abortionists never acknowledge birth-related mental health problems when they speak of women crying themselves to sleep after abortions.

    http://www.nmha.org/infoctr/factsheets/postpartum.cfm

    Given the hormonal changes associated with pregnancy, the stress involved in having to plead a case for an abortion, the difficult personal and social contexts in which abortion decisions are likely to made, and the operation itself, it would not be surprising to find that it is associated with heightened levels of depression.

    If it was found that men suffered depression after having a vasectomy, would that be a good reason to make vasectomies illegal?

    Our abortion law is a farce and should be repealed.

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  2. Awesome post, Maia. I hoped you'd post on this as soon as I saw this was the top story on 3 News last night (!!!!!!!!).

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  3. In fact, the article was so shit I'm writing to them to tell them that now :) Ah, holidays...

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  4. Anonymous1:12 pm

    David Lange’s position in the parliamentary abortion debate was both logically and ethically flawed. He strongly defended his right to follow his own conscience on the matter, while voting to deny pregnant women the same right.

    However, his stance wasn’t punitive, like that of the 1977 Royal Commission on Contraception, Sterilisation and Abortion. In selecting the grounds on which abortions should be allowed, the morality of the pregnant woman was taken into account.

    “Laws should not be so rigorous that only a minority of citizens willingly obey them in their entirety, nor should they be geared to the level of conduct of those whose moral standards leave much to be desired”.

    Thus, they ruled out youth as a possible ground for abortion, saying that some girls under 16 might have been a willing party to sex and therefore have “no better claim to abortion” than those who were taken advantage of. Incest was okay as a ground for abortion because women with unwanted pregnancies would be unlikely to try to use it.

    Despite acknowledging that “Most people would regard it as quite unreasonable that a woman should be compelled to bear the child of someone who has made a violent sexual assault upon her against her will”, they excluded rape because they felt some women would allege rape to get an abortion they’d otherwise be denied.

    However, in the legislation that followed, extremes of age and sexual violation, while not grounds in themselves, are factors that can be taken into account.

    After noting that half of the patients of the Auckland Medical Aid Centre whose requests for abortion were turned down got abortions anyway, the Royal Commission report conceded that even when abortion is refused, “A woman who is determined to obtain abortion will pursue her purposes”. So, while they said that if their recommendations become law, there will be fewer abortions, presumably they meant fewer LEGAL abortions. It seems that women's determination has prevailed.

    If the anti-abortionists succeeded in tightening the abortion law today, they would not reduce the number of abortions by much, assuming that is their goal. Women will go to Australia as they did in the late 1970s.

    But they are not likely to succeed . The number of politicians who are both anti-abortion and willing to accept one of the likely consequences - a rise in the number of women on the DPB - is very small.

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  5. you may be interested to have a look at a kiwi male pro-choice perspective on this:
    http://stupidinternetname.blogspot.com/2006/01/nice-company-you-keep-terrorist-or-im.html

    (actually Maia, you would have met Mr Stupid back in Feb last year - you were sitting at the same table in Waihau Bay :-) )

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  6. Anonymous5:58 pm

    Hmmn, not sure that I'd describe Mr Stupid as "pro-choice" on the basis of this comment:

    "Anyway, none of this should be taken as signalling that I am rabidly pro-abortion. I am rabidly on the fence. That is to say, abortion isn't a good thing, but on balance I suspect banning it leads to a worse situation."

    Pro-choice means that it is not relevant what you personally think about abortion, unless you happen to be the pregnant woman having to make the choice about whether to continue with a pregnancy or terminate it.

    "Pro-abortion" could include forced abortion and the pro-choice position does not support that.

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  7. Anonymous10:16 am

    Mental Health Foundation CE calls for more abortion studies and cites US study with different findings

    http://www.nzherald.co.nz/section/story.cfm?c_id=5&ObjectID=10362475

    Ms Clements said the Canterbury research contrasted with a US study released in October which found no credible evidence that women who terminated a first pregnancy were at a higher risk of depression.

    "The [US] study's authors found pre-existing mental health to be a better predictor of depression risk than abortion."

    The US study also found that women who opted for a termination reported less depression than those who carried on with an unwanted pregnancy.

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  8. I'm constantly surprised that people try to prevent women from getting rid of a baby thay don't want.

    I didn't even bother reading the story as I knew it would drive me crazy. Since I've had kids i've been especially irked by pro-lifers.

    I know it makes no difference, but every time I go past them outside the hospital I tell them I don't think it is appropriate for them to be there.

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  9. I disagree about David Lange anonymous. He was one of the group who came up with the amendments that became legislation (and a principle drafter). The Royal Commission report had been successfully discredited by feminists, and their aim was to maintain a panel system in reality, but not in name.

    The fact that he tried to portray himself as a moderate (and wasn't in the house, so didn't have to vote for things like an amendment to grant women access to an abortion if they'd been raped) shows what a weasel he was.

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  10. I sometimes wonder if the world wouldn't be a better place if the news media were banned from reporting on research results. Every time, they report a correlation as though some causal factor had been uncovered, and usually the authors (if they aren't ambitious charlatans) have to spend ages trying to point out the difference between correlation and causality.

    I don't doubt the results for a second. But what if they compared 90 women who'd experienced any emotionally (and sometimes physically) traumatic event with 410 who hadn't? Might come up with the same result? Could be, who knows, which is why it's stupid to go rushing to print with headlines. And then there's the obvious, well-duh aspect noted by anon above:

    "The [US] study's authors found pre-existing mental health to be a better predictor of depression risk than abortion."

    No shit!? Thanks for posting this anonymous, it blows the case the anti-abortionists want to make from this study right out of the water.

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  11. Anonymous6:47 pm

    Might be of interest...


    January 6, 2006
    Editorial: Abortion Rights in Latin America

    by Editorial
    The New York Times

    For proof that criminalizing abortion doesn't reduce abortion rates and only endangers the lives of women, consider Latin America. In most of the region, abortions are a crime, but the abortion rate is far higher than in Western Europe or the United States. Colombia - where abortion is illegal even if a woman's life is in danger - averages more than one abortion per woman over all of her fertile years. In Peru, the average is nearly two abortions per woman over the course of her reproductive years.

    In a region where there is little sex education and social taboos keep unmarried women from seeking contraception, criminalizing abortion has not made it rare, only dangerous. Rich women can go to private doctors. The rest rely on quacks or amateurs or do it themselves. Up to 5,000 women die each year from abortions in Latin America, and hundreds of thousands more are hospitalized.

    Abortion is legal on demand in the region only in Cuba, and a few other countries permit it for extreme circumstances, mostly when the mother's life is at risk, the fetus will not live or the pregnancy is the result of rape. Even when pregnancies do qualify for legal abortions, women are often denied them because anti-abortion local medical officials and priests intervene, the requirements are unnecessarily stringent, or women do not want to incur the public shame of reporting rape.

    But Latin Americans are beginning to look at abortion as an issue of maternal mortality, not just maternal morality. Where they have been conducted, polls show that Latin Americans support the right to abortion under some circumstances. Decriminalization, at least in part, is being seriously discussed in Colombia, Brazil, Venezuela, Uruguay and Argentina, and perhaps will be on the agenda after the presidential election in July in Mexico.


    Found on http://pewforum.org/news/display.php?NewsID=6052

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